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ORIJINAL ARAŞTIRMA

İnme Sonrası Hemipleji Hastalarında Ağrısız Omuzun Ultrasonografik Değerlendirilmesi
Ultrasonographic Evaluation of Painless Shoulder in Patients with Post-Stroke Hemiplegia
Received Date : 22 Aug 2022
Accepted Date : 22 Nov 2022
Available Online : 24 Nov 2022
Doi: 10.31609/jpmrs.2022-92996 - Makale Dili: EN
J PMR Sci. 2023;26(1):494-502
ÖZET
Amaç: Bu çalışma, omuz ağrısı olmayan hemiplejik hastaların omuz ultrason (US) bulgularını değerlendirmek ve bunların motor evre, günlük yaşam aktiviteleri (GYA) ve fonksiyonel durum ile ilişkisini değerlendirmek amacıyla yapıldı. Gereç ve Yöntemler: Bu kesitsel çalışmaya, toplam 22 hemiplejik hasta ve 18 sağlıklı kontrol dâhil edildi. Tüm katılımcıların demografik verileri ile hemiplejik hastaların Brunnstrom motor evrelemesi [Brunnstrom recovery scale (BRS)], fonksiyonal ambulasyon skalası (FAS), Barthel indeksi ve kas tonusu analiz edildi. Sağlıklı kontroller ile hemiplejik hastaların omuz kıkırdak kalınlığı, akromiyoklaviküler eklem (AKE) derinliği ve omuz patolojisi derecelendirme ölçeği [ultrasound shoulder pathology rating scale (USPRS)] US ile değerlendirildi. Bulgular: Hasta ve sağlıklı kontrol gruplarının demografik verileri benzerdi. Hemiplejik omuzda total USPRS skoru ile ölçeğin her bir bileşenin skorları sağlıklı kontrollere göre anlamlı derecede yüksekti (p<0,01). Hemiplejik taraftaki kıkırdak kalınlığı ile AKE derinliğinin ortalama değeri, sağlıklı kontrollerin ölçümlerinden istatistiksel olarak farklıydı (p<0,017). USPRS skorları ile Barthel indeksi, BRS ve FAS arasında anlamlı ve orta düzeyde negatif bir korelasyon vardı (sırasıyla p=0,009, rho=-0,546; p=0,023, rho=-0,482; p=0,016, rho=-0,516). Sonuç: US, omuz kuşağındaki yumuşak doku değişikliklerini değerlendirmek için basit, noninvaziv ve erişilebilir bir yöntemdir. Ağrısız omuzu olan hemiplejik hastalarda US bulguları GYA, fonksiyonel durum ve motor iyileşme evreleri ile korele idi.
ABSTRACT
Objective: This study was performed to evaluate the shoulder ultrasound (US) findings of the hemiplegic patients without shoulder pain and to evaluate the relationship between the sonographic findings and the motor stage, activities of daily living (ADL), and functional status. Material and Methods: This cross-sectional study included a total of 22 hemiplegic patients and 18 healthy controls. The demographic data of all participants, and, Brunnstrom recovery scale (BRS), functional ambulation scale (FAC) scores, Barthel index, and muscle tone, were analyzed. Shoulder cartilage, deep joint space of the acromioclavicular joint (ACJ), and ultrasound shoulder pathology rating scale (USPRS) scores of healthy controls and hemiplegic patients were evaluated by the US. Results: The demographic data of the patient and healthy control groups were comparable. The total USPRS score and the scores of each component were significantly higher in the hemiplegic shoulder compared to healthy controls (p<0.01). The mean score of cartilage thickness and the width of the ACJ on the hemiplegic side were statistically significantly different from the measurements of the healthy controls (p<0.017). There was a significant and moderate negative correlation between the USPRS scores and Barthel index, BRS, and FAC (p=0.009, rho=-0.546; p=0.023, rho=-0.482; p=0.016, rho=-0.516 respectively). Conclusion: The US was a simple, non-invasive, and accessible method by which to evaluate soft tissue changes in the shoulder girdle. Its findings were correlated with ADL, functional status, and motor recovery stage in hemiplegic patients with painless shoulders
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